Treatment of Pure Red-Cell Aplasia With Cyclosporine in a Renal Transplant Patient

Abstract

Acquired pure red-cell aplasia is a rare disorder that can be either idiopathic or associated with certain autoimmune diseases, pregnancy, lymphoproliferative disorders, nutritional deficiencies, or medicines. We present a deceased-donor renal transplant patient who developed pure red-cell aplasia associated with mycophenolate mofetil or tacrolimus and was treated with cyclosporine. A 20-year-old woman was transplanted from a deceased donor 1 month earlier and presented to us with symptoms of fatigue, prostration, and palpitation. The results of a laboratory examination revealed anemia. A diagnostic work-up resulted in a diagnosis of pure red-cell aplasia. Mycophenolate mofetil was discontinued. Tacrolimus also was replaced with cyclosporine 2 months after mycophenolate mofetil was halted because of a lack of improvement in anemia. Three months later, her anemia improved with cyclosporine. Starting cyclosporine instead of tacrolimus or mycophenolate mofetil showed good improvement in our patient within 6 months of therapy.

An unusual case of anemia in a cardiac transplant recipient

“…Systemic corticosteroids are the drug of first choice, followed by immune modulating medications such as cyclosporine in those unable to achieve remission . Studies in renal transplant patients have shown that changing the immunosuppressant regimen can lead to improvement in anemia . IVIG also plays a role in treatment, typically in immune compromised patients with PRCA thought to be secondary to parvovirus B19 …”

“…12 Studies in renal transplant patients have shown that changing the immunosuppressant regimen can lead to improvement in anemia. 13 IVIG also plays a role in treatment, typically in immune compromised patients with PRCA thought to be secondary to parvovirus B19. 12 Our patient had 2 plausible causes of the primary anemia that we could identify, the anti-M antibody and the possible effect of mycophenolate mofetil.…”

Myelodysplastic Syndrome After Kidney Transplantation: Case Report

“…Ancak nakil hastalarında immünsupresyon sonrasında saf eritrosit aplazisi bildirilmiştir ve nakil sonrasında mikofenolat mofetil ile ilişkili MDS bildirimi bulunmamaktadır. 15 Olgumuzda, siklosporin ve mikofenolat mofetil kesilerek sirolimus başlanmıştır. MDS tedavisinde sitotoksik ajanlar ve immünsup-resifler kullanılabildiği gibi destek tedavi ile de hastalar takip edilmektedir.…”